Eggener Scott E, Roehl Kimberly A, Yossepowitch Ofer, Catalona William J
Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
J Urol. 2006 Oct;176(4 Pt 1):1399-403. doi: 10.1016/j.juro.2006.06.045.
Prostate specific antigen velocity 2.0 ng/ml per year or greater in the year before prostate cancer diagnosis is associated with cancer specific survival following radical prostatectomy and radiation therapy. We evaluated the relationship between prediagnosis prostate specific antigen velocity and cancer progression following primary radiation therapy.
We analyzed the records of 24,893 men from a community based prostate cancer screening study and identified 237 with clinically localized prostate cancer who elected primary radiation therapy. Our final cohort consisted of 130 men, including 83 treated with external beam radiation and 47 treated with brachytherapy. Patient specific variables at diagnosis were analyzed for their value in predicting biochemical progression using American Society for Therapeutic and Radiation Oncology criteria.
Mean followup +/- SD was 64 +/- 35 months. Prostate specific antigen at diagnosis, family history of prostate cancer and prediagnosis prostate specific antigen velocity 2.0 ng/ml per year or greater were associated with cancer progression following brachytherapy or external beam radiation. Of men with prostate specific antigen velocity 2.0 ng/ml per year or greater 38% had cancer progression compared to 12% with prostate specific antigen velocity less than 2.0 ng/ml per year (OR 4.3, p = 0.003). The 6-year progression-free survival estimate was 57% in men with prostate specific antigen velocity 2.0 ng/ml per year or greater and 82% in men with prostate specific antigen velocity less than 2.0 ng/ml per year (p < 0.001). On multivariate analysis absolute prostate specific antigen at diagnosis and prostate specific antigen velocity 2.0 ng/ml per year or greater were independently associated with cancer progression in men treated with external beam radiation therapy or brachytherapy.
Men with a prediagnosis prostate specific antigen velocity of 2.0 ng/ml per year or greater are at increased risk for cancer progression following brachytherapy or external beam radiation compared to men with a prostate specific antigen velocity of less than 2.0 ng/ml per year.
前列腺癌诊断前一年前列腺特异性抗原速度达到每年2.0 ng/ml或更高与根治性前列腺切除术及放射治疗后的癌症特异性生存相关。我们评估了诊断前前列腺特异性抗原速度与初次放射治疗后癌症进展之间的关系。
我们分析了一项基于社区的前列腺癌筛查研究中24,893名男性的记录，并确定了237例选择初次放射治疗的临床局限性前列腺癌患者。我们的最终队列由130名男性组成，其中83例接受外照射放疗，47例接受近距离放射治疗。使用美国放射肿瘤学会标准分析诊断时的患者特异性变量在预测生化进展方面的价值。
平均随访时间±标准差为64±35个月。诊断时的前列腺特异性抗原、前列腺癌家族史以及诊断前前列腺特异性抗原速度达到每年2.0 ng/ml或更高与近距离放射治疗或外照射放疗后的癌症进展相关。前列腺特异性抗原速度达到每年2.0 ng/ml或更高的男性中，38%发生了癌症进展，而前列腺特异性抗原速度低于每年2.0 ng/ml的男性中这一比例为12%（比值比4.3，p = 0.003）。前列腺特异性抗原速度达到每年2.0 ng/ml或更高的男性6年无进展生存率估计为57%，而前列腺特异性抗原速度低于每年2.0 ng/ml的男性为82%（p < 0.001）。多因素分析显示，诊断时的绝对前列腺特异性抗原以及前列腺特异性抗原速度达到每年2.0 ng/ml或更高与接受外照射放疗或近距离放射治疗的男性的癌症进展独立相关。
与前列腺特异性抗原速度低于每年2.0 ng/ml的男性相比，诊断前前列腺特异性抗原速度达到每年2.0 ng/ml或更高的男性在接受近距离放射治疗或外照射放疗后癌症进展风险增加。
